HomeGard Prime Policy Application

Property Address To Be Covered*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

YesNo

BuyerSellerHomeowner

Seller Name

First NameLast Name

Mobile Phone

Please enter a valid phone number.Format: (000) 000-0000.

Seller Email

example@example.com

Listing Start Date

Date

Buyer Name

First NameLast Name

Closing Date

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Buyer Email

example@example.com

Real Estate Office

Agent Name

First NameLast Name

Agent Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

DISCLOSURE: IN ADDITION TO REPRESENTING THE HOME SELLER AND/OR BUYER, THE NAMED REAL ESTATE AGENT, BROKER OR COMPANY MAY ALSO BE PERFORMING CERTAIN WARRANTY-RELATED PROCESSING, ADMINISTRATIVE, MARKETING AND OTHER SERVICES.

THE COVERAGE INCLUDES ONLY THOSE SYSTEMS, APPLIANCES AND COMPONENTS THAT WERE IN PROPER OPERATING CONDITION AT THE AGREEMENT EFFECTIVE DATE. THE FOLLOWING SYSTEMS, APPLIANCES AND COMPONENTS SHOULD BE EXCLUDED FROM COVERAGE:

By providing a telephone number and submitting the form, you consent to be contacted by SMS text message from HomeGard Home Warranty. Message frequency may vary. Message & data rates may apply. Reply STOP to opt out of further messaging. Reply HELP for more information

YES, I WANT WARRANTY COVERAGE: APPLICANT UNDERSTANDS THE TERMS AND CONDITIONS OF WARRANTY COVERAGE AND AUTHORIZES CLOSING AGENT TO PAY REQUIRED WARRANTY FEES UPON CLOSING.

Signature*

Date*

Date

HomeGard PRIME Options ($50 deductible first three claims)

HomeGard PRIME

HOMEGARD PRIME POLICY - Core Policy Features Plus Heating and Air Conditioning: Registers, grills, zone controllers, condensate line cleaning, condensate pumps, humidifiers, installation of flue liners to meet local codes resulting from furnace replacements Water Heater: Expansion Tank Plumbing: toilet bowl & tank failure up to $300, and garbage disposal resets. Electrical: hardwired smoke detectors, doorbell (excluding intercoms), ceiling fan (excludes lights, remote, noise, wobbling) Oven/Range/Cooktop: Rotisseries, racks, handles, knobs, dials, interior lining, range vents Dishwasher: racks, rollers, baskets Microwave Oven: knobs, racks, rotisserie, handles Trash Compactor: lock/key assemblies, knobs Kitchen Refrigerator: Ice crusher, beverage dispenser Miscellaneous: Repair or replacement of a system or appliance (excluding roofs) that was improperly installed, modified or repaired (excluding undersized/ mismatched systems); Labor charges incurred from repair or replacement arising from items covered under an existing manufacturer’s or distributor’s warranty; Drywall removal/replacement reimbursed up to $300; Ability to select own contractor for covered repairs, pending pricing approval.

$829.00

HomeGard PRIME BUYER

BUYER; COVERAGE TO BEGIN AT CLOSING

$ Free

HomeGard PRIME SELLER (Up to 180 days)

COVERAGE TO BEGIN AT ENROLLMENT, CONVERTS TO BUYER AT CLOSING

$ Free

OVER 5000 SQ. FT. COVERAGE OPTION

For policies with a property OVER 5000 Sq. Ft.

$500.00

WATER SOFTENER

OPTIONAL COVERAGE (BUYER ONLY) - Covers one (1) domestic water softener

$99.00

SEPTIC TANK

OPTIONAL COVERAGE (BUYER ONLY) - Includes jet pump, sewage ejector pump, aerobic pump, septic tank and clearing sewer line from house to septic tank

$99.00

WELL PUMP SYSTEM NO BOOSTER

OPTIONAL COVERAGE (BUYER ONLY) - All components and parts of one well pump utilized as the primary source of water to the home.

$74.00

WELL PUMP WITH BOOSTER

OPTIONAL COVERAGE (BUYER ONLY) - All components and parts of one well pump utilized as the primary source of water to the home.

$149.00

WET BAR REFRIGERATOR/ WINE COOLER/ ICE MAKER PACKAGE

Wet Bar Refrigerator (up to 16 cubic ft), Built-In Wine Cooler (30-bottle maximum), freestanding icemaker, additional refrigerator. All components that affect the cooling operation of the unit (up to a combined total of four appliances) including compressor, thermostat, condenser coil, evaporator, defrost system, motor and fill valve

$29.00

MULTI-UNIT PRICING (QUANTITY PER UNIT)

This option is for a duplex, triplex, quadplex, mother-in-law suite, coach house, additional kitchen.

$ Free Quantity

POOL AND/OR IN-GROUND SPA EQUIPMENT WITHOUT WATER HEATER

Shared equipment is covered. If equipment is not shared, then only one or the other is covered unless an additional fee has been paid. Covers above ground and accessible working components and parts of the heating, pumping, and filtration system including: Pool sweep motor and pump, pump motor, blower motor and timer, above ground plumbing pipes and wiring. The unit must be able to fill with water to qualify for coverage

$149.00

POOL AND/OR IN-GROUND SPA EQUIPMENT WITH WATER HEATER

Shared equipment is covered. If equipment is not shared, then only one or the other is covered unless an additional fee has been paid. Covers above ground and accessible working components and parts of the heating, pumping, and filtration system including: Pool sweep motor and pump, pump motor, blower motor and timer, above ground plumbing pipes and wiring. The unit must be able to fill with water to qualify for coverage

$199.00

Total

$0.00

Home Warranty Application

Seller Information

Buyer Information

Agent Information

POLICY OPTIONS